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1.
Rapid Commun Mass Spectrom ; : e8731, 2020 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-31960493

RESUMO

RATIONALE: Linear ion traps with simplified structure have been widely used in miniaturized mass spectrometers. However, linear ion traps usually have low ion detection efficiency when used in a miniaturized mass spectrometer, in which only one ion detector can be installed. To solve this problem, an asymmetric radio frequency voltage was applied to introduce the asymmetric electric fields in the trapping volume of the linear ion traps, which would lead to unidirectional ion ejection. METHODS: An asymmetric RF voltage was applied on both half round-rod electrode and triangular electrode linear ion traps, and their performances including unidirectional ion ejection efficiency and mass resolution were evaluated by computer simulation. The relationship between asymmetric RF voltage difference δ and internal electric field distribution was investigated, and the impact of δ and resonance excitation signal frequency on the unidirectional ion ejection efficiency and mass resolution was also explored. RESULTS: A unidirectional ion ejection efficiency of around 83% and a mass resolution of over 2700 were achieved with δ=7% in both half round-rod electrode and triangular electrode linear ion traps. CONCLUSIONS: By applying an asymmetric RF voltage, the ion detection efficiency could be significantly improved without any change of the structures of existing linear ion traps. This method provided a simple and general solution for improving the ion detection efficiency and sensitivity of miniaturized linear ion trap mass spectrometers.

2.
Scand J Gastroenterol ; 55(1): 123-128, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31906735

RESUMO

Background: This study aimed to compare the treatment outcomes and safety between stent placement with or without Iodine-125 (125I) seeds strand for patients with unresectable malignant obstructive jaundice (MOJ).Methods: A total of 84 patients with unresectable MOJ treated in our hospital were retrospectively included and divided into the stent group (n = 54) undergoing biliary stent placement and the stent + seeds group (n = 30) receiving stent placement with 125I seeds strand. The therapeutic outcome, postoperative complications, duration of patient survival and stent patency were compared between groups. Kaplan-Meier survival analysis was performed to compare the duration of patient survival and stent patency between groups. Cox-regression analysis was performed to investigate predictive factors for disease-free survival and overall survival.Results: The stent + seeds group had significantly longer duration of patency (231.57 ± 256.54 vs. 110.37 ± 120.52) and overall survival (310.57 ± 330.54 vs. 173.15 ± 219.40) than the stent group (both p < .05). In addition, Kaplan-Meier survival analysis confirmed that the stent + seeds group had longer duration of patency (log-rank test, p = .001) and higher overall survival rate (log-rank test, p = .020) than the stent group. Furthermore, Cox-regression analysis demonstrated that treatment methods was an independent factor associated with disease-free survival (HR: 0.36, 95% CI: 0.19-0.70; p = .003) and overall survival (HR: 1.01, 95% CI: 1.00-1.01; p < .001).Conclusion: The stent placement with 125I seeds strand can significantly improve the primary patency rate and overall survival time in MOJ patients.

3.
Mol Med Rep ; 21(2): 623-630, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31974593

RESUMO

Placental structural abnormalities and dysfunction in those with gestational diabetes mellitus (GDM) can lead to increased placental permeability, which is in turn related to a poorer maternal and fetal prognosis. The present study sought to assess whether increased placental permeability in rats with GDM was accompanied by alterations in tight junction (TJ) factors and to evaluate the impact of low molecular weight heparin (LMWH) on these factors. The present study was conducted using pregnant female rats that were randomized into control, GDM and GDM + LMWH groups. Diabetes was induced via intraperitoneal administration of streptozotocin to rats in the GDM and GDM + LMWH groups, whereas rats in the GDM + LMWH group received daily subcutaneous LMWH starting on day 5 of pregnancy. On gestational day 16, all rats were sacrificed and Evans Blue (EB) assay was used to gauge vascular permeability based on EB dye leakage. Transmission electron microscopy was further used to assess TJ structures, and the TJ proteins zonular occludens­1 (ZO­1) and occludin (OCLN) were assessed using immunohistochemistry and western blotting. Blood samples were obtained from the abdominal aorta for ELISA measurements of advanced glycation end products (AGEs) concentrations, and placental receptor for AGEs (RAGE) and vascular endothelial growth factor (VEGF) expression was assessed using reverse transcription­quantitative PCR. In addition, western blotting was used to measure placental NF­κB. Compared with in the control group, EB leakage was markedly increased in GDM group rats; this was associated with reduced ZO­1 and OCLN expression. Conversely, LMWH attenuated this increase in placental permeability in rats with GDM and also mediated a partial recovery of ZO­1 and OCLN expression. Blood glucose and serum AGEs concentrations did not differ between the GDM and GDM + LMWH groups. Furthermore, LMWH treatment resulted in decreases in RAGE and VEGF mRNA expression levels, which were upregulated in the GDM group, whereas it had the opposite effect on the expression of NF­κB. In conclusion, GDM was associated with increased placental permeability and this may be linked with changes in TJs. LMWH intervention mediated protection against this GDM­associated shift in placental permeability via the RAGE/NF­κB pathway.

5.
J Integr Plant Biol ; 2020 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-31912615

RESUMO

Endophytic fungi can be beneficial to plant growth. However, the molecular mechanisms underlying colonization of Acremonium spp. remain unclear. In this study, a novel endophytic Acremonium strain was isolated from the buds of Panax notoginseng and named Acremonium sp. D212. The Acremonium sp. D212 could colonize the roots of P. notoginseng, enhance the resistance of P. notoginseng to root rot disease, and promote root growth and saponin biosynthesis in P. notoginseng. Acremonium sp. D212 could secrete indole-3-acetic acid (IAA) and jasmonic acid (JA), and inoculation with the fungus increased the endogenous levels of IAA and JA in P. notoginseng. Colonization of the Acremonium sp. D212 in the roots of the rice line Nipponbare was dependent on the concentration of methyl jasmonate (MeJA) (2 to 15 µM) and 1-naphthalenacetic acid (NAA) (10 to 20 µM). Moreover, the roots of the JA signalling-defective coi1-18 mutant were colonized by Acremonium sp. D212 to a lesser degree than those of the wild-type Nipponbare and miR393b-overexpressing lines, and the colonization was rescued by MeJA but not by NAA. It suggests that the cross-talk between JA signalling and the auxin biosynthetic pathway plays a crucial role in the colonization of Acremonium sp. D212 in host plants. This article is protected by copyright. All rights reserved.

7.
Ann Glob Health ; 85(1): 134, 2019 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-31799127

RESUMO

Background: Mental disorders endanger people's health and lives. General practitioners (GPs) play a valuable role in identifying and treating mental disorders in outpatient clinical settings. However, there are obstacles for GPs' identification in developing countries. Objective: This study's aim was to identify the related obstacles and to propose optimized strategies. Methods: We conducted qualitative interviews with 26 GPs from seven randomly sampled community healthcare centers in Shanghai, China. The interview guide was based primarily on the items from mental status evaluation. After transcribing, coding, condensing, and categorizing talking content, we summarized the theme structure and results. Findings: GPs lacked the confidence and skills to conduct psychiatric evaluation and seldom conducted it. Patients' behaviors also influenced whether evaluations were conducted. The GPs expressed that they were short of strategies and wished to be well trained and have sufficient practice. We found that two major reasons impeded GPs' identification. First, the GPs had difficulty making a diagnosis: they lacked diagnostic ability and confidence, they had misunderstandings about diagnoses, and they had unclear qualifications for making psychiatric diagnoses. Second, the GPs lacked skills for evaluation and reevaluation: their evaluation had inadequacies of contents and subjects; they lacked mental state examination evaluation, communication, and severity assessment skills and knowledge. Conclusions: This study found that it is difficult for GPs in developing countries to become competent in the diagnosis and systematic evaluation of mental disorders without external help. Unclear qualification also limited GPs' diagnoses of mental disorders. We proposed that optimized strategies to overcome these challenges lie in support of changes in policy, programs, and utilizing effective tools, such as the mhGAP, GMHAT/PC, BVC, Grille's assessment tool, and telemedicine.

8.
Cell Reprogram ; 21(6): 314-322, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31809209

RESUMO

Periodontitis is a chronic inflammatory disease that can lead to the loss of periodontal bone tissue. The osteogenic potential of periodontal ligament stem cells (PDLSCs) is significantly decreased in periodontitis microenvironment. However, the mechanism is still unclear. We used Porphyromonas gingivalis lipopolysaccharide (LPS) as a stimulator of PDLSCs to mimic the periodontal inflammatory environment. The mineralization capability was restrained in LPS-stimulated PDLSCs, and the level of miR-148a increased, while the level of Neuropilin 1 (NRP1) decreased. Downregulation of miR-148a could reverse the osteogenesis deficiency of PDLSCs under LPS treatment. In addition, the expression of miR-148a in PDLSCs was negatively correlated with the expression of NRP1. Furthermore, overexpression of NRP1 upregulated the osteogenesis ability of LPS-stimulated PDLSCs, while inhibition of NRP1 eliminated the stimulative effect of miR-148a inhibitor on osteogenic differentiation. These data illustrated that the inflammatory environment mimicked by LPS inhibits osteogenesis by upregulation of miR-148a and subsequent downregulation of NRP1. We also found, compared to healthy periodontal tissues, miR-148a level increased, while NRP1 level decreased in periodontitis tissues. These two phenomena also exist in PDLSCs that come from the upper two types of tissues. To summarize, the decline of osteogenic potential of PDLSCs under inflammatory condition of periodontitis is related to miR-148a/NRP1 functional axis. This study may provide a novel strategy in the molecular aspect for the therapy of periodontitis.

9.
Regen Med ; 2019 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-31829095

RESUMO

Aim: To determine the efficacy and safety of intracoronary infusion of autologous bone marrow mesenchymal stem cells (MSCINJ) in combination with intensive atorvastatin (ATV) treatment for patients with anterior ST-segment elevation myocardial infarction-elevation myocardial infarction. Patients & methods: The trial enrolls a total of 100 patients with anterior ST-elevation myocardial infarction. The subjects are randomly assigned (1:1:1:1) to receive routine ATV (20 mg/d) with placebo or MSCsINJ and intensive ATV (80 mg/d) with placebo or MSCsINJ. The primary end point is the absolute change of left ventricular ejection fraction within 12 months. The secondary end points include parameters in cardiac function, remodeling and regeneration, quality of life, biomarkers and clinical outcomes. Results & conclusion: The trial will implicate the essential of cardiac micro-environment improvement ('fertilizing') for cell-based therapy. Clinical Trial Registration: NCT03047772.

10.
Artigo em Inglês | MEDLINE | ID: mdl-31769597

RESUMO

Antegrade dissection reentry with Stingray device (Boston Scientific, Marlborough, MA) accounts for 20-34% of the chronic total occlusion (CTO) cases in the various hybrid operators' CTO registries and is an important component of CTO crossing algorithms. The Stingray device can facilitate antegrade dissection and reentry, however its use is low outside North America and Europe. The Asia Pacific CTO Club along with three experience Stingray operators from the US, Europe and India, created an algorithm guiding use of the CrossBoss and Stingray catheter. This APCTO Stingray algorithm defines when to use the CrossBoss and Stingray device recommending a reduction in CrossBoss use except for in-stent restenosis lesions and immediate transition from knuckle wiring to the Stingray device. When antegrade wiring fails, choice of Stingray-facilitated reentry versus parallel wiring depends on operator experience, device availability, cost concerns, and anatomical factors. When the antegrade wire enters the subintimal space, we recommend using a rotational microcatheter to produce a channel and deliver the Stingray balloon-so called the "bougie technique." We recommend early switch to Stingray rather than persisting with single wire redirection or parallel wire. We recommend choosing a suitable reentry zone based on preprocedural computer tomography or angiogram, routine use of stick and swap, routine use of Subintimal TRAnscatheter Withdrawal (STRAW) through the Stingray balloon, and the multi stick and swap technique. We believe these techniques and algorithm can facilitate incorporation of the Stingray balloon into the practice of CTO interventionists globally.

11.
J Glob Health ; 9(2): 020702, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31673344

RESUMO

Methods: Using an interrupted time series design, we conducted segmented regression analyses of utilization changes of targeted anti-cancer medicines covered by the provincial government health insurance program during 2013 to 2016 in 69 hospitals with more than 100 beds in Hangzhou, the capital city of Zhejiang province of China. The WHO/Health Action International Project on Medicine Prices and Availability methodology was used to measure patient affordability of the study medicines. Results: In March 2015, the utilization of all study medicines increased by 15.58 (95% CI = 3.86, 27.30, P = 0.01) to 439.14 standard units (95% CI = 311.79, 566.49, P < 0.001). Before covered by government health insurance, the estimated out-of-pocket payment by patient ranged from 3.0 to 13.1 times of the provincial average disposable annual income per capita for urban residents, and 6.2 to 27.3 times for rural residents. Such payments were reduced to 0.6 to 2.1 times for urban residents and 1.8 to 4.4 times for rural population after government health insurance coverage inclusion. During 2015 to 2016, the per capita contribution to Hangzhou catastrophic health insurance program was CNY15 (US$ 2.3), and the reimbursement rate was 70% in Hangzhou city. The cumulative total insurance expenses on six study targeted anticancer medicines accounted for an estimated 53% of the total amount of premiums of the government catastrophic health insurance fund. Sensitivity analyses indicated that this proportion would have changed to 46%, 61% and 69% when changing the per capita contribution to CNY25 (US$ 3.8) and CNY40 (US$ 6.2), and changing the insurance reimbursement rate to 60%, 80 and 90%. Conclusion: Government health insurance coverage inclusion significantly increased utilization of the expensive targeted anti-cancer medicines, and improved patient affordability. However, the financial burden of patients is still high, especially for the rural low-income population. Rising utilization and expenditures call for careful monitoring of anti-cancer medicines use, and for strategies to decrease prices to facilitate medicines access and keep the insurance system sustainable.

12.
J Geriatr Cardiol ; 16(10): 741-748, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31700513

RESUMO

Objective: To investigate whether the very elderly patients with non-ST-segment elevation myocardial infarction (NSTEMI) will benefit from an invasive strategy versus a conservative strategy. Methods: 190 consecutive patients aged 80 years or older with NSTEMI were included in the retrospective study from September 2014 to August 2017, of which 69 patients received conservative strategy and 121 patients received invasive strategy. The primary outcome was death. Multivariate Cox regression models were used to assess the statistical association between strategies and mortality. The survival probability was further analyzed. Results: The primary outcome occurred in 17.4% patients in the invasive group and in 42.0% patients in the conservative group (P = 0.0002). The readmission rate in the invasive group (14.9%) was higher than that in the conservative group (7.2%). Creatinine level (OR = 1.01, 95% CI: 0.10-1.03, P = 0.05) and use of diuretic (OR = 3.65, 95% CI: 1.56-8.53, P = 0.003) were independent influential factors for invasive strategy. HRs for multivariate Cox regression models were 3.45 (95% CI: 1.77-6.75, P = 0.0003), 3.02 (95% CI: 1.52-6.01, P = 0.0017), 2.93 (95% CI: 1. 46-5.86, P = 0.0024) and 2.47 (95% CI: 1.20-5.07, P = 0.0137). Compared with the patients received invasive strategy, the conservative group had remarkably reduced survival probability with time since treatment (P < 0.001). Conclusions: An invasive strategy is superior to a conservative strategy in reducing mortality of patients aged 80 years or older with NSTEMI. Our results suggest that an invasive strategy is more suitable for the very elderly patients with NSTEMI in China.

13.
Nanoscale ; 11(43): 20847-20856, 2019 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-31657433

RESUMO

Quasi-two-dimensional (Q-2D) perovskites are one kind of efficient luminescent material with fast energy transfer and radiative decay of excitons due to the energy cascade formed by the mixed perovskite phase. However, the existence of monolayer or bilayer nanosheets in the Q-2D perovskite film results in poor charge transport, high trap density and rough film surface because of the high ratio of ligands, which leads to poor performance of Q-2D perovskite light-emitting diodes (PeLEDs). Herein, we proposed a new strategy of a pre-solution mixing (PSM) precursor to inhibit the formation of ultrathin perovskite nanosheets, which significantly enhanced the charge carrier mobility, reduced the concentration of defects and improved the film morphology. The PeLEDs based on the PSM precursor achieved the maximum luminescence of 7832.1 cd m-2 (∼218% enhancement) and the peak current efficiency of 6.0 cd A-1 (∼131% enhancement). By introducing mixed cations in the PeLED, the maximum brightness of 14 211.0 cd m-2 and current efficiency of 14.6 cd A-1 were realized, demonstrating the generality of our PSM method for the preparation of high performance PeLEDs.

14.
Int J Cancer ; 2019 Oct 03.
Artigo em Inglês | MEDLINE | ID: mdl-31583695

RESUMO

This study aimed to compare the differences in characteristics and prognoses between Asian and white patients receiving immunotherapy for nonsmall cell lung cancer (NSCLC). We studied 390 patients who received atezolizumab as part of the POPLAR or OAK trial, and analyzed the differences in baseline characteristics, outcomes and genetic mutations in blood samples between Asian and white patients. Overall survival (OS) was longer in Asian compared to white patients (median OS: 18.7 vs. 11.1 months; p = 0.005). Race was identified as an independent prognostic factor for OS (Asian vs. white: hazard ratio 0.647, 95% confidence interval 0.447-0.936, p = 0.021), together with performance status, histology, baseline sum of the longest tumor diameters (BLSLD) and number of metastatic sites. The two groups also differed in terms of characteristics including smoking history, BLSLD, epidermal growth factor receptor (EGFR) mutation frequency, programmed death-ligand 1 expression and blood-based tumor-mutation burden. Blood mutations of STK11, EGFR, KEAP1, POLE, GRM3, ATM and STAG2 were associated with treatment response, and TP53, KEAP1, APC, RB1, CREBBP, EPHA5 and STAG2 mutations were associated with OS. The blood-based mutation profiles differentiated between Asian and white patients, especially in relation to EGFR (23.8 vs. 8.5%), TP53 (30.2 vs. 46.9%) and STK11 (1.6 vs. 12.3%) mutations (all p < 0.05). The different clinicopathological features and mutation profiles in Asian and white patients may explain the superior outcome following atezolizumab treatment in Asian patients with NSCLC. The results of this study have important implications for further studies on racial disparities in relation to immunotherapy.

15.
Front Oncol ; 9: 886, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31572680

RESUMO

The oral multi-targeted tyrosine kinase inhibitor (TKI) anlotinib is effective for non-small cell lung cancer (NSCLC) in clinical trials at 3rd line. However, a fraction of patients remains non-responsive, raising the need of how to identify anlotinib-responsive patients. In the present study, we aimed to screen potential biomarkers for anlotinib-responsive stratification via integrated transcriptome analysis. Comparing with the anlotinib-sensitive lung cancer cell NCI-H1975, we found 1,315 genes were differentially expressed in anlotinib-resistant NCI-H1975 cells. Among the enriched angiogenesis-related genes, we observed high expression of KLK5 and L1CAM was mostly associated with poor clinical outcomes in NSCLC patients through Kaplan-Meier survival analysis in a TCGA cohort. Moreover, an independent validation in a cohort of ALTER0303 (NCT02388919) indicated that high serum levels of KLK5 and L1CAM were also associated with poor anlotinib response in NSCLC patients at 3rd line. Lastly, we demonstrated that knockdown of KLK5 and L1CAM increases anlotinib-induced cytotoxicity in anlotinib-resistant NCI-H1975 cells. Collectively, our study suggested serum levels of KLK5 and L1CAM potentially serve as biomarkers for anlotinib-responsive stratification in NSCLC patients at 3rd line.

16.
Cardiol J ; 2019 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-31565793

RESUMO

Coronary artery disease (CAD) is currently the leading cause of death globally, and the prevalence of this disease is growing more rapidly in the Asia-Pacific region than in Western countries. Although the use of metal coronary stents has rapidly increased thanks to the advancement of safety and efficacy of newer generation drug eluting stent (DES), patients are still negatively affected by some the inherent limitations of this type of treatment, such as stent thrombosis or restenosis, including neoatherosclerosis, and the obligatory use of dual antiplatelet therapy (DAPT) with unknown optimal duration. Drug-coated balloon (DCB) treatment is based on a leave-nothing-behind concept and therefore it is not limited by stent thrombosis and long-term DAPT; it directly delivers an anti-proliferative drug which is coated on a balloon after improving coronary blood flow. At present, DCB treatment is recommended as the first-line treatment option in metal stent-related restenosis linked to DES and bare metal stent. For de novo coronary lesions, the application of DCB treatment is extended further, for conditions such as small vessel disease, bifurcation lesions, and chronic total occlusion lesions, and others. Recently, several reports have suggested that fractional flow reserve guided DCB application was safe for larger coronary artery lesions and showed good long-term outcomes. Therefore, the aim of these recommendations of the consensus group was to provide adequate guidelines for patients with CAD based on objective evidence, and to extend the application of DCB to a wider variety of coronary diseases and guide their most effective and correct use in actual clinical practice.

17.
J Exp Bot ; 70(21): 6229-6244, 2019 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-31408172

RESUMO

Embryogenesis is an essential process during seed development in higher plants. It has previously been shown that mutation of the Arabidopsis non-SMC element genes AtNSE1 or AtNSE3 leads to early embryo abortion, and their proteins can interact with each other directly. However, the crucial regions of these proteins in this interaction and how the proteins are cytologically involved in Arabidopsis embryo development are unknown. In this study, we found that the C-terminal including the Ring-like motif of AtNSE1 can interact with the N-terminal of AtNSE3, and only the Ring-like motif is essential for binding with three α motifs of AtNSE2 (homologous to AtMMS21). Using genetic assays and by analysing molecular markers of cell fate decisions (STM, WOX5, and WOX8) in mutant nse1 and nse3 embryos, we found that AtNSE1 and AtNSE3 work non-redundantly in early embryo development, and that differentiation of the apical meristem and the hypophysis fails in the mutants, which have disrupted auxin transportation and responses. However, the upper cells of the suspensor in the mutants seem to have proper embryo cell identity. Cytological examination showed that cell death occurred from the early embryo stage, and that vacuolar programmed cell death and necrosis in the nse1 and nse3 mutant embryos led to ovule abortion. Thus, AtNSE1 and AtNSE3 are essential for maintaining cell viability and growth during early embryogenesis. Our results improve our understanding of the functions of SMC5/6 complex in early embryogenesis in Arabidopsis.

18.
Analyst ; 144(17): 5127-5135, 2019 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-31338496

RESUMO

A portable linear ion trap mass spectrometer featuring a compact three-stage vacuum system, a continuous atmospheric pressure interface (CAPI), and a miniature ion funnel was developed and characterized. The dimensions and weight of the instrument were 38 × 26 × 23 cm3 and ∼20 kg, respectively. The combination of a three-stage vacuum system and CAPI reduced the pressure smoothly from atmospheric to ∼5 × 10-4 Torr, ensuring that the miniature ion funnel, quadrupole ion guide, and linear ion trap operated in a suitable and stable vacuum environment. The analytical performance of the instrument was evaluated with a nano-electron spray ionization source and a reserpine sample solution. A satisfactory mass resolution up to 4060 (m/Δm, FWHM) was achieved at m/z 609 when the mass scan rate was 495 Da s-1. Unit mass resolution was achieved at a mass scan rate of 6000 Da s-1. In addition, a limit of detection of 5 ng mL-1 was achieved and tandem mass spectrometry (MS3) was successfully performed with the instrument. Furthermore, the measurements showed high repeatability and stability (RSD < 6%). This portable mass spectrometer shows great potential for practical applications in on-site analyses, such as those required for food safety, drug analysis, environmental protection, forensic investigations, and homeland security.

20.
Heart Lung Circ ; 2019 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-31320259

RESUMO

BACKGROUND: The use of a retrograde approach and algorithm-driven CTO (chronic total occlusion) percutaneous coronary intervention (PCI) has become widespread, and many registries have reported good results. This study established a new algorithm and applied it to current CTO practice and collected a CTO registry to document the results. It compared the outcomes of a retrograde versus antegrade approach in a contemporary multicentre CTO registry. METHODS: Between 1 January 2016 and 31 December 2016, consecutive patients who underwent CTO PCI performed by eight high-volume CTO operators were included in a registry. RESULTS: During this period, 485 patients with 497 CTOs were treated with technical and procedural success rates of 93.8% and 89.9%, respectively. Antegrade and retrograde technical success was 95.9% and 91.2% (p = 0.03), respectively. Procedural success for antegrade and retrograde was 94.4% and 84.6%, respectively (p < 0.001). The pure retrograde success rate was 80% and pure antegrade success rate was 75%. Technical success in different Japanese Chronic Total Occlusion (JCTO) score groups was 100% (JCTO 0), 96.2% (JCTO 1), 95.3% (JCTO 2), and 92.5% (JCTO ≥ 3), with no statistical difference in success rates between different JCTO scores. In-hospital major adverse cardiac event (MACE) was 3.8% and more common in the retrograde group (6.6% vs 1.5%). CONCLUSIONS: The retrograde approach, when used by experienced operators who have been well trained in retrograde approach, can produce higher retrograde success in complex CTO lesions. The use of an algorithm approach can improve procedural efficiency, reduce contrast and radiation dosage, and reduce the time spent in failure mode. These tools remain vital to the development of future CTO PCI.

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